Alzheimer's Disease

Dementia and Bladder Removal

08/15/2008

Question:

My dad 84, has dementia and bladder cancer. Should he have the surgery to remove bladder - concerned about quality of life?

Answer:

This is a very difficult question to answer and an issue that is receiving more and more attention in clinical practice and research. Often individuals with dementia receive less aggressive treatment of cancer, this may be due to poor symptom recognition and diagnoses at later stages of the disease, as well as the decision by older adults and their families to chose less invasive treatments or forgo treatment all together if the life expectancy is expected to be brief. It is a challenge to find the right mix of curative vs. palliative treatment for a person with dementia. There are ethical dilemmas involved. It is not appropriate to not treat cancers in individuals with dementia, but at what point does the treatment become too aggressive and potentially stressful, leading to poor quality of life for the person?

You are right in focusing your question around concerns about quality of life. An in depth discussion with your dad's doctor and with all of you as a family to help you better weigh the factors contributing to quality of life appears to be essential. For example, at what stage of dementia is he? What is his overall health and medical status? What does the surgery involve? Often, the stress of surgery and anesthesia impacts individuals with dementia in a much more adverse way than an older adult without dementia. What are the risks involved? What will happen if he does not have the surgery? What happens if he does have the surgery? If your dad is able to communicate, can you ask him what his wishes are? Did he have any advanced directives about his medical care?

There is no easy yes/no answer for your question. It is clear that you are focusing on what will provide the best quality of life for your father. Continuing to approach this problem with this framework will lead you to make the best decision you can.

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